Anesthesiology and Risk Assessment Quiz

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Questions and Answers

What is the mortality rate for a patient classified as ASA Class III?

0.1 %

1.8 % (correct)

9.4 %

7.8 %

Which ASA classification represents a patient who is expected to survive without surgery for 24 hours?

Class IV

Class V

Class I (correct)

Class II (correct)

What condition does NOT typically define ASA Class IV?

Obesity (correct)

Unstable angina

Renal failure

Respiratory failure requiring mechanical ventilation

Which ASA class is characterized by a constant threat to life and is classified with a mortality rate of 7.8 %?

Class IV Signup and view all the answers

Which of the following statements about ASA Class II is true?

Patients have no significant impact on daily activities. Signup and view all the answers

What is the point value assigned to a patient over 70 years of age according to Goldman’s Cardiac Risk Index?

5 points Signup and view all the answers

Which class in Goldman’s Cardiac Risk Index indicates a life-threatening complication risk of 22%?

Class IV Signup and view all the answers

What is the minimum fasting duration for solid food before surgery according to preoperative fasting guidelines?

6 hours Signup and view all the answers

Which of the following conditions would NOT be a reason to postpone surgery?

Presence of acute bladder infection Signup and view all the answers

Which patient condition assigns a score of 11 points according to Goldman’s Cardiac Risk Index?

Heart attack in the last 6 months Signup and view all the answers

What effect do benzodiazepines have when combined with other CNS depressants?

Additive effect enhancing sedation Signup and view all the answers

What is a potential risk of using anticoagulants during surgical procedures?

Increased risk of haemorrhage Signup and view all the answers

Which of the following substances can induce liver enzymes, leading to increased dosages of anaesthetic agents?

Alcohol Signup and view all the answers

How do calcium antagonists affect the use of inhalational anaesthetics?

They enhance the effects of inhalational agents, potentially causing hypotension Signup and view all the answers

What is a potential consequence of hypokalaemia in patients using diuretics during surgery?

Dysrhythmias and prolonged neuromuscular blockade Signup and view all the answers

What is one of the necessary elements for consent to be valid?

The patient must have the capacity to consent to the treatment offered. Signup and view all the answers

Which of the following best describes the period of validity of consent?

Consent remains valid as long as the patient's condition remains the same. Signup and view all the answers

What should be done if there is a change in the nature of the patient's illness?

A new consent must be obtained from the patient. Signup and view all the answers

What is emphasized as part of the discussion during the consent process?

Possible risks and complications specific to the patient. Signup and view all the answers

Which step is important to confirm before discussing the treatment plan with the patient?

Check that the patient understands who you are and your role. Signup and view all the answers

What is one of the primary goals of preoperative assessment?

To ensure the patient is in optimal condition Signup and view all the answers

In which scenario should elective surgery be postponed?

When the patient exhibits unstable symptoms Signup and view all the answers

What component is NOT part of the preoperative assessment process?

Psychological evaluation Signup and view all the answers

Which of the following statements is true regarding emergent surgery?

Risks should be weighed against ongoing resuscitation benefits. Signup and view all the answers

Which is a key component of preoperative assessment?

Problem identification Signup and view all the answers

Who is primarily responsible for carrying out the preoperative assessment?

Multidisciplinary healthcare personnel Signup and view all the answers

Which of the following assessments is included in the prediction of perioperative morbidity and mortality?

Review of surgical history Signup and view all the answers

What is the purpose of developing a rapport with the patient during preoperative assessment?

To facilitate a discussion regarding the patient's surgery Signup and view all the answers

What is a primary consideration when selecting an anaesthetic technique?

Site of operation Signup and view all the answers

Which of the following is NOT a component of preanaesthetic routine preparation?

Performing an x-ray Signup and view all the answers

What is the primary purpose of administering benzodiazepines as premedication?

Anxiolysis and amnesia Signup and view all the answers

Which drug is commonly used as an anti-emetic to prevent postoperative nausea and vomiting?

Metoclopramide Signup and view all the answers

Which premedication aims to reduce salivary secretions in the patient?

Glycopyrrolate Signup and view all the answers

What is the effect of administering high doses of atropine?

Sedation and hallucination Signup and view all the answers

What is the primary reason for administering sodium citrate before general anaesthesia?

To neutralize residual gastric acidity Signup and view all the answers

Which of the following premedication drugs has no analgesic properties?

Benzodiazepines Signup and view all the answers

Which of the following agents would be considered for aspiration prophylaxis in a morbidly obese patient?

H2 antagonists Signup and view all the answers

What is the primary role of premixed opioids in anaesthetic preparation?

Providing analgesia Signup and view all the answers

Study Notes

Preoperative Assessment

Preoperative visits are essential for safe and successful anesthesia.
The aim of preoperative assessment is to identify medical and anesthetic risks to reduce morbidity and mortality.
Anesthetic drugs and techniques have profound effects on human physiology.
A focused review of all major organ systems is needed before surgery.
The goal of preoperative evaluation is to ensure the patient is in the best condition possible.
Patients with unstable symptoms should be postponed for optimization prior to elective surgery.
Emergent surgery in unstable patients requires careful consideration of risks versus benefits.

Objectives

Evaluate and optimize the patient's medical condition.
Plan anesthetic technique and peri-operative care.
Develop rapport with the patient to reduce anxiety and facilitate anesthesia.
Allow appropriate discussion between patient/guardian and medical staff.
Obtain informed consent.

Definition of Timing of Surgery

Emergent: Required when life or limb is threatened without immediate surgery.
Urgent: Procedure is required within 24 hours.
Semi-Urgent: Condition where disease progression is undesirable (e.g., cancer), and should be addressed as soon as possible.
Elective: Surgery can be scheduled without time constraints.

Classification of Operation (NCEPOD)

Immediate: To save life, limb, or organ; target time to theatre - within minutes (e.g., major trauma with uncontrolled hemorrhage).
Urgent: Acute onset or deterioration of condition threatening life or limb/organ; surgery when resuscitation is complete (e.g., compound fracture, perforated viscus).
Expedited: Stable patient needing early intervention; target time to theatre - within days (e.g., closed fractures, some tumor surgeries).
Elective: Surgery planned and booked in advance; all conditions not covered in categories 1-3 (e.g., joint replacements, cholecystectomies).

Key Components of Preoperative Assessment

Problem Identification: Focused history, examination, review of investigations, and response to treatment.
Risk Assessment: Plan of anesthetic technique (pre-operative, intra-operative, post-operative).

General Principles

Personnel: preoperative clinic visit by medical staff.
Place: appropriate setting.
Timing: patient's condition is considered.
Preoperative admission: patient undergoes necessary procedures/tests.
Multi-disciplinary management: all relevant departments involved.
Emergency surgery: addressed quickly.

Process of Preoperative Evaluation

History (including review of medical records)
Physical examination
Laboratory evaluation
Prediction of perioperative morbidity and mortality
Documentation (informed consent, preoperative note).

Preoperative History

Presenting condition and concurrent medical history, (e.g., bowel cancer, malnutrition, anemia, electrolyte imbalance).
Coexisting medical conditions (e.g., cardiovascular, respiratory, angina, previous MI, heart failure, hypertension, preexisting lung disease, rheumatoid disease, diabetes, renal disease).

Assessment of Capacity of Cardiorespiratory System

Metabolic equivalent (MET) levels: ratio of metabolic rate during a physical activity to resting metabolic rate.
MET score correlates with activity levels from light housework to strenuous exercise.

NYHA Classification

Class I: No limitation of physical activity.
Class II: Slight limitation of physical activity.
Class III: Marked limitation of physical activity.
Class IV: Unable to carry out any physical activity without discomfort.

Medication History

Generally, most long-term medications should be continued up to the morning of surgery, but this needs discussion with surgeon.
Drug interactions need to be considered.
Previous surgical procedures and anesthetic history: documented.
Exposure to specific anesthetic agents should be avoided if contraindicated (e.g., halothane).
Family history with focus on potential problems, like prolonged apnea, malignant hyperthermia.

Medications That May Interact With Anesthetic Agents

ACE inhibitors (ACEIs) have synergistic interactions with anesthetics causing hypotension.
Antibiotics increase neuromuscular blocking effect.
Anticoagulants increase hemorrhage risk.
Anticonvulsants and benzodiazepines have additive effects with CNS depressants.
Beta-blockers have negative inotropic effects that can worsen hypotension.
Calcium channel blockers may increase the effects of inhalational agents.
Diuretics can cause hypokalemia, potentially prolonging neuromuscular blockade.

Smoking: nicotine triggers tachycardia, hypertension, CO reduces O2 carriage, and stops 6-12 weeks before surgery for optimal effects.
Alcohol: may induce liver enzyme induction, increasing the minimum alveolar concentration (MAC) needed for an anesthetic.

Physical Examination

Nutritional state and fluid balance.
Blood pressure.
Heart sounds.
Respiratory status.
Airway assessment.
Nervous system assessment.

Anatomical Factors Associated With Difficult Laryngoscopy

Short, muscular neck.
Protruding incisors ("buck teeth").
Receding lower jaw.
Poor mobility of mandible.
Decreased atlanto-occipital distance (requires X-ray).

Mallampati Classification

Classifies airway suitability.

Thyromental Distance (TMD)

Measurement from thyroid cartilage to chin.
Normal distance is greater than 6.5 cm.

Sterno-mental Distance (SMD)

Measurement from manubrium to chin.
Normal distance is greater than 12 cm.

Inter-incisor Distance

Distance between incisors, measured with maximal mouth opening.
Greater than 4 centimeters is considered normal.

Cormack-Lehane Classification

Visualization of laryngeal aperture (I-IV).

Upper Lip Bite Test

Classifies mandibular movement.

Mandibular Protrusion Test

Classifies how far lower incisors can protrude.

LEMON Rule

Method to assess airway.

Quick Airway Assessment

Assess the patient's ability to open their mouth, protrude their tongue, move their jaw forward, and fully turn/extend their neck/head.

Predictors of Difficulty to Face Mask Ventilate (OBESE)

Obese patients.
Bearded patients
Elderly patients.
Snoring.
Patients with no teeth (edentulous).

Laboratory Evaluation

Only necessary investigations should be performed.
Healthy, minimally invasive procedures might not require extensive lab tests.

Routine Investigations for Asymptomatic Patients

Age and type of surgery determine required tests.

Investigations for Patients With Abnormal Clinical Findings

Investigations based on specific abnormal indications.

Period of Validity of Tests

Varies based on test (blood work is usually 1 week; ECG is usually 1 month; chest X-ray is typically 6 months).

Risk Assessment

Patient's medical condition before surgery.
Extent of surgical procedure.
Risk from the anesthetic.

"Clear the Patient for Surgery"

A summary for the approval of a patient for surgery.

Prediction of Perioperative Morbidity and Mortality (ASA)

This chart helps to predict the risks associated with surgery.
Categorizes patients based on physical health status.
Mortality rates are associated with each class.

Goldman's Cardiac Risk Index

Risk factors for cardiac problems during surgery.
Uses a point system.

Risks According to Type of Surgery

Based on the type of operation, risk factor tables are provided.
Categorized into low, intermediate, and high-risk surgeries.

Postponing Surgery

Situations that warrant delaying surgery.

Preoperative Fasting Guideline

Guidelines on how long before surgery various foods are to be discontinued/not eaten by a patient.

Informed consent includes reasonable explanation of options, sufficient information on procedures, risks, written consent, history, physical examination, laboratory results, consultant recommendations, and anesthetic plan.

A summary of the steps for a patient to understand the procedures, risks, and consent their choices under physician guidance.

Discuss type of anesthetic, time for decision

Emphasize the importance of the patient understanding and having time to make decisions.

Consent is valid until the patient's condition changes.
When the patient's condition or need for the procedure changes, a new consent must be obtained.

Capacity to consent.
Sufficient information.
Voluntariness in decision-making.

Factors for Selection of Anesthetic Technique

Safety of patient.
Preexisting systemic disorders.
Site of operation.
Age of patient.
Patient preference.
Anaesthetist ability.

Preaesthesic Routine Preparation

Provide psychological support/reassurance to a patient.
Perform patient fasting requirements.
Ensure patients are void before surgery.
Verify patient's false teeth removal, absence of lip/eye make-up or nail polish.
Confirm proper identification labeling.
Obtain mandatory consent.
Administer premedication as needed.

Premedication

Administration of drugs within 1-2 hours before induction.
Objectives: induce anxiolysis and amnesia, prevent aspiration, and counteract autonomic effects.
Drug groups include those to decrease anxiety or induce amnesia, prevent vomiting, counteract autonomic responses and provide analgesia, e.g., benzodiazepines, antidepressants, anti-emetics etc.
Types and doses of pre-medication vary based on patient indications.

Aspiration Prophylaxis

Indications: pregnancy, morbid obesity, large abdominal mass, hiatus hernia, and gastro-esophageal reflux.
Interventions include antacids - sodium citrate, H2 antagonists - ranitidine and cimetidine, proton pump inhibitors - omeprazole and pantoprazole and prokinetics - metoclopramide.

Plan of Anesthesia

Local or regional anesthesia with standby monitoring and/or sedation.
General anesthesia with or without intubation (spontaneous or controlled ventilation).
Combined regional with general anesthesia.

Suitable Anesthetic Techniques For Different Types of Surgery

Different types of surgeries require different anesthetic techniques (local, regional, or general).

Further Review

The review of the patient's entire medical history, current conditions, and other relevant details as indicated.

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Description

Test your knowledge on ASA classifications, Goldman’s Cardiac Risk Index, and preoperative fasting guidelines with this quiz. Each question challenges your understanding of patient assessment and surgical risk. Perfect for medical students and healthcare professionals in the anesthesiology field.